Fighting HIV/AIDS, tuberculosis (TB), and malaria
globally is a priority for Congress. The 108th and 110th Congresses enacted two pieces of legislation that have
shaped U.S. responses to these diseases: P.L. 108-25, the United States
Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
(Leadership Act), and P.L. 110-293, the Tom Lantos and Henry J.
Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and
Malaria Reauthorization Act of 2008 (Lantos-Hyde Act). The Leadership Act
authorized $15 billion to be spent from FY2004 through FY2008 on fighting
HIV/AIDS, TB, and malaria. The Lantos-Hyde Act amended the Leadership Act
to authorize $48 billion for fighting the three diseases from
FY2009 through FY2013.

The Leadership Act (and the legislation that it amends) is the primary vehicle
through which U.S. global assistance for fighting these diseases is
authorized. The Lantos-Hyde Act mostly amends the Leadership Act, though
it amends some other acts, such as the Foreign Assistance Act of 1961, and
includes some stand-alone authorities. The Leadership Act and the Lantos-Hyde
Act (primarily through amendments to the Leadership Act) created
frameworks for how the funds should be spent, established program goals
and targets, and established coordinating offices for managing
government-wide responses.

The Leadership Act required the President to establish the Coordinator of the
United States Government Activities to Combat HIV/AIDS Globally (known as
the Global AIDS Coordinator) at the Department of State. Congress
appropriates the bulk of global HIV/AIDS funds to the Office of the Global
AIDS Coordinator, which leads the President’s Emergency Plan for
AIDS Relief (PEPFAR). The Global AIDS Coordinator distributes the majority
of these funds to U.S. federal agencies and departments and multilateral
groups like the Global Fund to Fight AIDS, Tuberculosis and Malaria. The
Lantos-Hyde Act amended the Leadership Act to establish the Coordinator of
the United States Government Activities to Combat Malaria Globally (known
as the Malaria Coordinator) at the U.S. Agency for International
Development (USAID) to oversee implementation of related efforts by USAID
and the Centers for Disease Control and Prevention.

Some authorities within these Acts are enduring, such as those that created the
Global AIDS and Malaria Coordinator positions (Leadership Act, as amended)
and permitted U.S. participation in advance market commitments for vaccine
development (Lantos-Hyde Act). Other authorities, however, are set to
expire, such as language authorizing funding for global HIV/AIDS, TB,
and malaria programs.

This report explains which authorities within the Leadership and Lantos-Hyde
Acts are set to expire and which are permanent. Table A-1 in the Appendix
A offers a side-by-side comparison of the Leadership Act in its
original form and the Lantos-Hyde Act, which amends the Leadership Act and
other legislation. A third column explains which sections are set to expire
and summarizes language in S. 1545 and H.R. 3177 that amend the Leadership
Act, as amended. The Leadership Act, as amended and Lantos-Hyde Act
include comprehensive reporting requirements. Table A-2 in the Appendix
A lists the reporting requirements and describes the extent to
which the Administration has complied with the requirements.

Rather than revisit some of the contentious issues that dominated debate when
crafting the Lantos-Hyde Act, House and Senate Members introduced
legislation (H.R. 3177 and S. 1545) that is narrowly aimed at key
priorities: enhancing oversight of U.S. global HIV/AIDS, TB, and malaria programs; authorizing appropriations for the Global Fund through
FY2018; and allocating a portion of HIV/AIDS funds for orphans and vulnerable
children (OVC) and for HIV/AIDS treatment and care. Table B-1 in Appendix
B summarizes key amendments in the bills, entitled the PEPFAR
Stewardship and Oversight Act.

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